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Professor John Deanfield on foiling heart disease

John Deanfield’s healthy lifestyle helped him succeed first as an Olympian, and then as a top cardiologist and researcher. He tells Sarah Brealey how heart disease starts much earlier than you think.

Professor John Deanfield has his own entry on Wikipedia, the crowd-sourced online encyclopaedia. But it doesn’t cover his achievements as one of the UK’s most eminent cardiologists, with hundreds of research papers to his name.

Instead, the brief entry describes his participation as a fencer in the 1972 and 1976 Olympics. The cardiologist smiles ruefully and says: “It shows you people’s priorities, I suppose.” There can’t be many leading cardiologists who are also former Olympians. The BHF Professor of Cardiology at University College London says: “That was a fantastic experience for me. It taught me about the importance of a healthy lifestyle."

Fencing taught me about the importance of a healthy lifestyle

Professor John Deanfield

Reducing heart and circulatory disease risk is a theme that runs through Professor Deanfield’s work. Early in his career, he worked at Great Ormond Street Hospital, where treatments for children born with heart defects were being pioneered.

“I fell in love with the children, and I have spent a lot of time treating children with congenital heart disease,” he says. “Treating them as they grew older made me aware that even teenagers (whether they have congenital disease or not) can have the signs of adult heart disease, and I became interested in how that can be prevented.”

When Professor Deanfield’s career started, children were beginning to survive who previously would have died in infancy. He’s helped create a new specialism – looking after teenagers and young adults with congenital heart disease. Now, for the first time, this group of children can be studied in later life.“We are now in a new phase,” he explains, “looking at what happens to them as they grow older and encounter risk factors for coronary heart disease, when they may still have underlying structural defects in their hearts. It’s what I call Star Trek medicine – we are boldly going where no one has gone before.”

Invest in your arteries

What Professor Deanfield learned from studying children and teenagers is relevant to everyone. He wants us all to “invest in our arteries”, starting as early in life as possible. He is particularly proud of the difference he’s made in changing attitudes to the lifetime management of heart and circulatory disease.

“Doctors traditionally wait for people to get sick and treat them quite late in the development of the disease,” he says. “We should start thinking about this much earlier in your life. It is like financial planning – you wouldn’t start saving for retirement when you’re 64. It’s about convincing people their heart health really matters and if they take action early in life and sustain that, they will get a huge lifetime benefit in reducing their risk of heart disease.”

Professor Deanfield with his fencing team in the 1970s.

How old is your heart?

With this in mind, Professor Deanfield has played a key role in the development of the Heart Age Tool. Launched in February last year in collaboration with the BHF, more than two million people have already used it to get an estimate of their ‘heart age’. This estimates the age at which you might have a heart attack or stroke and offers guidance on how to reduce your risk.

Professor Deanfield says: “The Heart Age Tool takes the end results of years of research and translates this into messages that we can all apply to our heart health. If people get that message, it’s a powerful promoter of lifestyle change, as well as promoting treatment in the right people.” Clinical trials of a similar tool showed it resulted in people reducing their risk factors for heart disease. “If I tell my patients their heart age is 10 years older than they are, they will say: ‘What can I do to get it down?’” says Professor Deanfield. “Then we can talk about smoking, losing weight or reducing blood pressure or cholesterol levels.”

Understanding atherosclerosis

Taking actions like this works because it reduces your risk of atherosclerosis – a condition in which your arteries become clogged by fatty substances known as plaques or atheroma. This condition lies behind heart attacks, stroke, peripheral arterial disease and most cases of angina. Alongside his work as a cardiologist, Professor Deanfield has studied atherosclerosis for more than 30 years.

In the early 1980s, researchers realised that the endothelium – a single layer of cells on the inside surface of blood vessels – played a key role in the early stages of atherosclerosis. But existing tests were invasive and unsuitable for use on children.

We are boldly going where no one has gone before

Professor John Deanfield

Professor Deanfield and his colleagues developed a technique, using a simple device similar to a blood pressure cuff. By inflating and deflating the cuff, blood flow can be changed. How the blood vessel reacts to these changes can be measured non-invasively using ultrasound. The results of the study were published in the Lancet in 1992.

“In a sense, that is the paper I am most proud of,” says Professor Deanfield. “It has changed the way people study endothelial function in a clinical setting. It took it out of the lab and into general use.”

Healthy endothelial cells produce nitric oxide, a gas that allows the blood vessels to function normally, including dilating in response to increased blood flow. Professor Deanfield showed that changes in the endothelium – in particular, reduced production of nitric oxide – can be detected before there is any visible evidence of atherosclerosis, and predict later development of the disease.

Building on this work, Professor Deanfield later showed that inflammation in the body – such as gum disease – is linked to atherosclerosis and endothelial function, and that effective treatment of gum disease improves endothelial function.

“Since then, we have shown that if you sort out gum disease in people with diabetes, it leads to improvements in measures like kidney function and control of your blood sugars,” he says. “That is exciting new research that we have just completed, which has public health implications and also helps us understand arterial disease.”

Olympic hopes

This August, Professor Deanfield will be following the Rio Olympics with interest. He no longer fences (“I don’t like to do things worse than I could do them before”) but retains “wonderful memories” and keeps in touch with his former fencing colleagues. He says it’s too early to say whether the London 2012 Olympics will have any long-term effect on public health.

The Heart Age Tool is a powerful promoter of lifestyle change

Professor John Deanfield

“There is certainly more interest in the different types of sports, but how that translates to the health of people is unclear,” he says. “Many people are not doing the recommended 150 minutes a week of exercise, and that applies to many other countries too, not just the UK. That is what I am trying to change, in a small way, through our research.”

Professor Deanfield is 64 and has “no intention of stopping work”. The links between heart and circulatory disease and inflammation remain a focus of his research. He’s also looking at other health issues, particularly dementia, including Alzheimer’s disease and vascular dementia.

“The evidence is out there; we just haven’t grasped it yet,” he says. “What is good for the heart is good for the brain. It’s important to communicate that to the public and create a way to predict brain decline – a brain age tool, perhaps. This is something I am working on, supported by the BHF. It could be very exciting.”

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